Interest in multifunctional structures made automatically from multiple materials poses a challenge for today's additive manufacturing (AM) technologies; however the ability to process multiple materials is a fundamental advantage to some AM technologies. The capability to fabricate multiple material parts can improve AM technologies by either optimising the mechanical properties of the parts or providing additional functions to the final parts. The objective of this paper is to give an overview on the current state of the art of multiple material AM technologies and their practical applications. In this paper, multiple material AM processes have been classified and the principles of the key processes have been reviewed comprehensively. The advantages and disadvantages of each process, recent progress, challenging technological obstacles, the possible strategies to overcome these barriers, and future trends are also discussed.

There has been a trend in recent years to develop polyetheretherketone (PEEK)-based medical devices due to the excellent cell biocompatibility and desirable mechanical properties of PEEK, which has elastic modulus comparable to cortical bone. Different manufacturing techniques such as injection moulding, particulate leaching, compression moulding, and selective laser sintering (SLS) have been used to produce porous PEEK for biomedical applications. Despite a large number of publications on extrusion-based additive manufacturing (AM) of porous structures using various materials, there have been very few general reports on extrusion AM of low quality small PEEK parts without defects such as warpage and delamination and no further assessment of mechanical properties. Successful low-cost 3D printing of PEEK structures using filament-based extrusion AM process is reported in this paper for the first time. Hot extrusion head design, extrusion temperature, and ambient temperature were identified as important factors need to be taken into consideration for printing PEEK structures without warpage, delamination, and polymer degradation. Compression and tensile tests were conducted to investigate mechanical properties of these new 3D printed PEEK structures. The air gap between infill pattern and entrapped micro-bubbles inside filaments were identified as the main source of mechanical properties reduction. In addition, three-point flexural test was performed on the 3D printed PEEK and compared with flexural specimens printed using other AM materials and techniques.

Addition of bioactive materials such as calcium phosphates or Bioglass, and incorporation of porosity into polyetheretherketone (PEEK) has been identified as an effective approach to improve bone-implant interfaces and osseointegration of PEEK-based devices. In this paper, a novel production technique based on the extrusion freeforming method is proposed that yields a bioactive PEEK/hydroxyapatite (PEEK/HA) composite with a unique configuration in which the bioactive phase (i.e., HA) distribution is computer-controlled within a PEEK matrix. The 100% interconnectivity of the HA network in the biocomposite confers an advantage over alternative forms of other microstructural configurations. Moreover, the technique can be employed to produce porous PEEK structures with controlled pore size and distribution, facilitating greater cellular infiltration and biological integration of PEEK composites within patient tissue. The results of unconfined, uniaxial compressive tests on these new PEEK/HA biocomposites with 40% HA under both static and cyclic mode were promising, showing the composites possess yield and compressive strength within the range of human cortical bone suitable for load bearing applications. In addition, preliminary evidence supporting initial biological safety of the new technique developed is demonstrated in this paper. Sufficient cell attachment, sustained viability in contact with the sample over a seven-day period, evidence of cell bridging and matrix deposition all confirmed excellent biocompatibility.

Additive manufacturing (AM) is a broad term encompassing 3D printing and several other varieties of material processing, which involve computer-directed layer-by-layer synthesis of materials. As the popularity of AM increases, so to do expectations of the medical therapies this process may offer. Clinical requirements and limitations of current treatment strategies in bone grafting, spinal arthrodesis, osteochondral injury and treatment of periprosthetic joint infection are discussed. The various approaches to AM are described, and the current state of clinical translation of AM across these orthopedic clinical scenarios is assessed. Finally, we attempt to distinguish between what AM may offer orthopedic surgery from the hype of what has been promised by AM.